NRG 303: Care of the Older Person
Overview of Aging: Chapter 1 Trends and
Issues
Historical Perspective on the Study of Aging
1960s -sociologists, psychologists, and health
care providers focused their attention on
meeting the needs of the typical or average
adult: people between 20 and 65 years of age.
- This group was the largest and most
economically productive segment of the
population; they were raising families,
working, and contributing to the
economy.
- Only a small percentage of the
population lived beyond age 65.
Disability, illness, and early death were
accepted as natural and unavoidable.
Late 1960s - research began to indicate that
adults of all ages are not the same
- At the same time, the focus of health
care shifted from illness to wellness.
- Disability and disease were no longer
considered unavoidable parts of aging.
- Increased medical knowledge, improved
preventive health practices, and
technologic advances helped more
people live longer, healthier lives.
- Older adults now constitute a significant
group in society, and interest in the
study of aging is increasing.
- The study of aging will be a major area
of attention for years to come.
GERIATRIC:
- -Greek words “geras,” meaning old age,
and “iatro,” meaning relating to medical
treatment.
- deals with the physiology of aging and
with the diagnosis and treatment of
diseases affecting older adults.
- by definition, focuses on abnormal
conditions and the medical treatment of
these conditions.
GERONTOLOGY
- Greek words “gero,” meaning related to
old age, and “ology,” meaning the study
of.
- Thus, gerontology is the study of all
aspects of the aging process, including
the clinical, psychologic, economic, and
sociologic problems of older adults and
the consequences of these problems for
older adults and society
- affects nursing, health care, and all
areas of our society—including housing,
education, GERONTICS, OR
GERONTIC NURSING business, and
politics.
GERONTOPHOBIA
- the fear of aging and the refusal to
accept older adults into the mainstream
of society
- senior citizens and younger persons can
fall prey to such irrational fears
Gerontophobia sometimes results in very odd
behavior.
● Teenagers buy anti-wrinkle creams.
● Thirty-year-old women consider facelifts.
● Forty-year-old women have hair
transplants.
● Long-term marriages dissolve so that
one spouse can pursue someone
younger.
Often these behaviors arise from the fear of
growing older.
MYTH: Older adults…
● Are pretty much all alike.
● Generally are alone and lonely.
● Tend to be sick, frail, and dependent on
others.
● Are often cognitively impaired.
● Suffer from depression.
● Become more difficult and rigid with
advancing years.
● Can barely cope with the inevitable
declines associated with aging.
FACTS: Older adults… DEMOGRAPHICS
● Are a very diverse age group.
● Typically maintain close contact with
family.
● Usually live independently.
● May experience some decline in
intellectual abilities, but it is usually not
severe enough to cause problems in
daily living.
● Generally have lower rates of
diagnosable depression when they live
in community settings, when compared
with younger adults.
● Tend to maintain a consistent
personality throughout the life span.
● Typically adjust well to the challenges of
aging.

AGEISM
- is the disliking of aging and older adults
based on the belief that aging makes
people unattractive, unintelligent, and
unproductive.
- It is an emotional prejudice or
discrimination against people based
solely on age.
- allows the young to separate
themselves physically and emotionally
from the old and to view older adults as
somehow having less human value.

AGE DISCRIMINATION
- reaches beyond emotions and leads to
actions; older adults are treated
differently simply because of their age.

Ex. refusing to hire older people, not approving

them for home loans, and limiting the types or
amount of health care they receive

- Illegal
- Some older adults respond to age
discrimination with a passive
acceptance, whereas others are
banding together to speak up for their
rights.

The extreme forms of gerontophobia are

ageism and age discrimination.

Healthcare Provisions
MEDICARE AND MEDICAID
- government program that provides
health care funding for older adults and
disabled persons.
RISING COSTS AND LEGISLATIVE ACTIVITY
- costs of health care have increased
dramatically in recent years.
- The United States spends more money
on health care than any other country in
the world, yet health care is not provided
for all U.S. citizens.
COSTS AND END-OF-LIFE CARE
- not all older people use the available
health care resources equally.
- Most health care services are consumed
by the very ill or terminally ill minority,
many of whom happen to be older
adults.
- Financial concerns are forcing health
care providers and society to face
ethical dilemmas regarding the
allocation of limited health care
resources.
Advance Directive and POLST
ADVANCE DIRECTIVES
- are legally recognized documents that
specify the types of care and treatment
the individual desires when that
individual cannot speak for himself or
herself.
Areas typically addressed in advance directives
include:
1. do not attempt to resuscitate (DNAR) or
allow natural death (AND) orders
2. directives related to mechanical
ventilation
3. directives related to artificial nutrition
and hydration.
Two formal types of advance directive are
recognized in most states:
1. the durable power of attorney for health
care
2. the living will.
Information about both of these is typically
provided when a person enters the hospital.
POLST, or physician orders for life-
sustaining treatment
- a legal document that has been adopted
by several states and takes the person’s
wishes further by creating actual
doctor’s orders to be carried out by
emergency personnel.
- contains three or four sections,
depending on the state, including
specifics about:
● CPR (whether to attempt resuscitation
or allow natural death)
● medical interventions (comfort care,
limited interventions, or full treatment
including when to transfer to hospital)
● antibiotics (use freely, use for comfort,
or don’t use at all)
● artificial nutrition (no tube feeding,
trial of tube feeding, or long-term tube
feeding)
Impact of Aging in The Family
Demographic Changes Affective the Family
● Extended life spans are leading to more
older family members.
● More people are living with chronic
conditions and need some degree of
care or assistance.
● The number of people in the younger
generations is decreasing in proportion
to the number of older members.
● There is an increasing number of
widows who may be unprepared to
provide for their own needs and will
need assistance.
● The role of women is changing. As
women increasingly must work outside
the home, many are attempting to meet
 the demands of the parents, home,
children, and workplace.
A family crisis may occur when the aging
person is no longer able to live alone.
Most families find that there is no perfect
solution.
The two most common options:
● bringing the aging parent into the home
of one of the children
● placing the parent in a long-term care
facility
THE NURSE AND FAMILY INTERACTIONS
● When we as nurses care for older
adults, particularly in hospital or nursing
home settings, we see the person only
as he or she is now.
● We often forget that these people have
not always been old. They lived, loved,
worked, argued, and wept as each of us
does.
● Often, the older adults we care for are
very ill or infirm, and, as nurses, we tend
to focus on their physical needs, cares,
and treatments.
● In our preoccupation with our duties, we
can easily lose our perspective of the
older patient as both a person and a
member of a family.
● Coping with stresses related to aging is
difficult for both the aging individual and
for the family.
● The behavior we see at any given time
is the best that the person is capable of
at that time. That does not mean that it
is the best that he or she will be capable
of at some other time.
● We as nurses need to examine the
stresses affecting the family so that we
can best respond to the needs of all
family members.
ABUSE and NEGLECT are usually something
done to someone, but, unfortunately, self-
neglect is a common problem in the older adult
population.
SELF-NEGLECT
- is defined as the failure to provide for
the self because of a lack of ability or
lack of awareness.
- is more likely to be seen when an older
person has few or no close family or
friends, but it can occur despite their
presence.
Because our society has laws to protect the
rights of adults, it may be difficult for concerned
parties to intervene until a situation has reached
critical or even life threatening proportions.
Indicators of self-neglect include the following:
● The inability to maintain activities of
daily living such as personal care,
shopping, meal preparation, or other
household tasks
● The inability to obtain adequate food
and fluid as indicated by malnutrition or
dehydration
● The inability to manage personal
finances as indicated by the failure to
pay bills or by hoarding, squandering, or
giving away money inappropriately
● Changes in mental function, such as
confusion, inappropriate responses,
disorientation, or incoherence
● Poor hygiene practices as indicated by
body odor, sores, rashes, or inadequate
or soiled clothing
● Failure to keep important business or
medical appointments
● Life-threatening or suicidal acts, such
as wandering, isolation, or substance
abuse
Abusive behavior cannot be justified at any
time or in any way.
Intentional abuse - is most likely to occur in
families with preexisting behavioral or social
problems.
High risk families - include those that have a
history of family conflict and those with a history
of violence or substance abuse, those with
mental impairment of either the dependent
person or caregiver, and those with severe
financial problems or unemployment
Unintentional abuse or neglect - is most likely
to occur when the caregiver lacks the necessary
knowledge, stamina, or resources needed to
care for an older loved one.
Often, the caregiver is an older spouse or an
aging child who physically cannot meet the high-
level care demands. Situations that trigger
abuse are more likely when the older person
requiring care is confused or needs continual
care.
ABUSE can be physical, financial,
psychological, or emotional.
Neglect and abandonment also constitute
forms of abuse.
Signs the Older Person May Be Experiencing
Abuse
● Excessive agreement or compliance
with the caregiver
● Signs of poor hygiene such as body
odor, uncleanliness, or soiled clothing or
undergarments
● Malnutrition or dehydration
● Burns or pressure sores
● Bruises, particularly clustered on trunk
or upper arms
● Bruises in various stages of healing that
may indicate repeated injury
● Inadequate clothing or footwear
● Inadequate medical attention
● Lack of food, medication, or care
● Verbalization of being left alone or
isolated
● Verbalization of fear of the caregiver
● Verbalization of a lack of control in
personal activities or finances
Abusive Behaviors in Health Care Settings
● Use of sedative or hypnotic drugs that
are not medically necessary
● Use of restraints when they are not
medically indicated
● Use of derogatory language, angry
verbal interactions, or ethnic slurs
● Withholding of privileges such as snacks
or cigarettes
● Excessive roughness in handling during
care or during transfers
● Delay in taking a resident to the
bathroom or allowing a resident to lie in
body waste
● Consumption of a resident’s food
● Theft of money or personal belongings
● Physical striking or any other assaultive
behavior toward a resident
● Violation of a resident’s right to make
decisions
● Failure to provide privacy
ELDER ABUSE IN INSTITUTIONS
Abuse in institutional settings is most likely to
occur when the nursing assistants are forced to
work under stressful conditions and have a poor
ability to deal with the stress. The risk for abuse
increases when caregivers perceive that they
are not valued, supported, or acknowledged.
The following are ways that may help decrease
stress and the likelihood of abuse:
● Create a positive team environment with
full staffing; convey true respect and
appreciation for the work every team
member does
● Encourage staff to take breaks on time
and to rest and re-energize with healthy
snacks. Provide a staff member
responsible for “break relief” so that care
may continue during breaks.
 ● Rotate any “difficult” assignment, to
avoid overwhelming any one team
member.
● Improve staff training to identify and
defuse potential situations.
● Initiate a stress-reduction program,
including staff support groups and
exercise options.
● Recognize the value of nursing assistant
to the team’s effort by involving them in
care planning and consulting with them
regarding potential problems and
possible solutions.
● Increase recognition of good,
compassionate caregiving through
verbal praise, employee-of-the-month
recognition, bonuses, and other
rewards.
● Institute a “get to know the resident”
program, whereby on a monthly basis,
one resident is featured, with
accomplishments from his or her past.
Team members may be surprised to
learn that the dependent older adults
they now care for once served as an
elite military special forces member,
raised twelve children, volunteered as a
docent at the local aquarium, or played
in a rock band.
● Provide an institutional mechanism for
dealing with nursing assistants’
complaints and concern in a proactive
rather than punitive manner.
SUPPORT GROUPS
- A wide variety of services to reduce
abuse and to meet the emotional and
physical needs of older adults and their
caregivers are available.
- Caregivers who want or need to share
their experiences and frustrations have
started forming support groups to help
one another cope with stress.
- Support groups allow caregivers to
share their feelings and to learn new
strategies to improve coping skills.
RESPITE CARE
- allows the primary caregiver to have
time away from the demands of
caregiving, thereby decreasing stress
and the risk for abuse.
- gives the primary caregiver the
opportunity to attend church, go
shopping, conduct personal business,
obtain medical care, or simply
participate in leisure activities
Chapter 2: Theories of Aging
“For the unlearned, old age is winter; for the
learned, it is the season of the harvest.”
-Hasidic
Maximal life expectancy - for humans today
appears to be 120 years but why is this so?
Theories of aging - have been considered
throughout history as mankind has sought to find
way to avoid aging
● No one has identified a single unified
rationale for why we age and why
different people live lives of different
lengths.
● Theories about to help explain and give
some logical order to our observations.
● Observations, including physical and
behavioral data are collected and
studied to scientifically prove or disprove
their effects on aging.
Theory vs Fact
Fact: Observations about the world around us
Ex. “It's bright outside.”
- observation
Theory: A well-substantiated explanation
acquired through the scientific method and
repeated tested and confirmed through
observation experimentation.
- Observation with scientific basis
Ex. “When the sun is out, it tends to make it
bright outside.”
BIOLOGIC THEORIES
Programmed theory
- proposes that everyone has a “biologic
clock” that starts ticking at conception.
- In this theory, each individual has a
genetic “program” specifying an
unknown but predetermined number of
cell divisions. As the program plays out,
the person experiences predictable
changes such as atrophy of the thymus,
menopause, skin changes, and graying
of the hair.
Run-out-of-program theory
- proposes that every person has a
limited amount of genetic material that
will run out eventually
Rate of living theory
- Proposes that individuals have a finite
number of breaths or heartbeats that are
used up over time.
Gene theory
- proposes the existence of one or more
harmful genes that activate over time,
resulting in the typical changes seen
with aging and limiting the life span of
the individual.
Error theory
- proposes that errors in ribonucleic acid
protein synthesis cause errors to occur
in cells in the body, resulting in a
progressive decline in biologic function
Somatic mutation theory
- is similar but proposes that aging results
from deoxyribonucleic acid (DNA)
damage caused by exposure to
chemicals or radiation and that this
damage causes chromosomal
abnormalities that lead to disease or
loss of function later in life.
Free radical theory
- provides one explanation for cell
damage
- Free radicals are unstable molecules
produced by the body during the normal
processes of respiration and metabolism
or following exposure to radiation and
pollution
- These free radicals are suspected to
cause damage to the cells, DNA, and
the immune system
Excessive free radical accumulation in the body
is purported to contribute to the physiologic
changes of aging and a variety of diseases,
such as:
● Arthritis
● circulatory diseases
● Diabetes
● atherosclerosis
One free radical, named lipofuscin, has been
identified to cause a buildup of fatty pigment
granules that cause age spots in older adults
Individuals who support this theory propose that
the number of free radicals can be reduced by
the use of antioxidants, such as:
● vitamins A, C, and E
● Carotenoids
● Zinc
● Selenium
● Phytochemicals.
Crosslink or connective tissue theory
- which proposes that cell molecules from
DNA and connective tissue interact with
free radicals to cause bonds that
decrease the ability of tissue to replace
itself. This results in the skin changes
typically attributed to aging such as
dryness, wrinkles, and loss of elasticity
Wear-and-tear theory
- presumes that the body is similar to a
machine, which loses function when its
parts wear out. As people age, their
cells, tissues, and organs are damaged
by internal or external stressors.
- When enough damage occurs to the
body’s parts, overall functioning
decreases. This theory also proposes
 that good health maintenance practices
will reduce the rate of wear and tear,
resulting in longer and better body
function
Clinker theory
- combines the somatic mutation, free
radical, and crosslink theories to
suggest that chemicals produced by
metabolism accumulate in normal cells
and cause damage to body organs,
such as the muscles, heart, nerves, and
brain.
Neuroendocrine theory
- focuses on the complicated chemical
interactions set off by the hypothalamus
of the brain.
- With age, the hypothalamus appears to
be less precise in regulating endocrine
function, leading to age-related changes
such as decreased muscle mass,
increased body fat, and changes in
reproductive function
Reliability theory of aging and longevity
- is a complex mathematical model of
system failures first used to describe
failure of complex electronic equipment.
It is used as a model to describe
degradation (disease) and failure
(death) of human body systems
Immunologic theory
- proposes that aging is a function of
changes in the immune system.
- According to this theory, the immune
system— an important defense
mechanism of the body— weakens over
time, making an aging person more
susceptible to disease.
- The immunologic theory also proposes
that the increase in autoimmune
diseases and allergies seen with aging
is caused by changes in the immune
system.
PSYCHOSOCIAL THEORIES
Disengagement theory
- was developed to explain why aging
persons separate from the mainstream
of society
- This theory proposes that older people
are systematically separated, excluded,
or disengaged from society because
they are not perceived to be of benefit to
the society
- This theory further proposes that older
adults desire to withdraw from society as
they age; the disengagement is mutually
beneficial.
Activity theory
- proposes that activity is necessary for
successful aging.
- Active participation in physical and
mental activities helps maintain
functioning well into old age
- Purposeful activities and interactions
that promote self-esteem improve
overall satisfaction with life, even at an
older age.
- “Busy work” activities and casual
interaction with others were not shown
to improve the self-esteem of older
adults.
Life-course theories
- are perhaps the theories best known to
nursing. These theories trace
personality and personal adjustment
throughout a person’s life
- Many of these theories are specific in
identifying life-oriented tasks for the
aging person. Four of the most common
theories—Erikson’s, Havighurst’s,
Newman’s, and Jung’s—are worth
exploring.
Erikson’s Eight Stages of Psychosocial
Development
Trust vs Mistrust - infant
● If needs are dependably met, infants
develop a sense of basic trust
Autonomy vs Shame and doubt - toddler
● Toddlers learn to exercise will and do
things for themselves, or they doubt
their abilities
Initiative vs Guilt - pre-schooler
● Preschoolers learn to initiate tasks and
carry out plans, or they feel guilty about
efforts to be independent
Industry vs Inferiority - grade shooler
● Children learn the pleasure of applying
themselves to tasks, or they feel inferior
Identity vs Identity confusion - teenager
● Teenagers work at refining a sense of
self by testing roles and then integrating
them to form a single identity or they
become confused about who they are
Intimacy vs Isolation - young adult
● Young adults struggle to form close
relationships to gain the capacity for
intimate love, or they feel socially
isolated
Generativity vs Stagnation - middle-age adult
● The middle-aged discover a sense of
contributing to the world, usually through
family and work, or they may feel a lack
of purpose
Integrity vs Despair - older adult
● When reflecting on his or her life, the
older adult may feel a sense of
satisfaction or failure
Havighurst’s theory
- details the process of aging and defines
specific tasks for late life, including:
● adjusting to decreased physical
strength and health;
● adjusting to retirement and
decreased income;
● adjusting to the loss of a
spouse;
● establishing a relationship with
one’s age group;
● adapting to social roles in a
flexible way; and
● establishing satisfactory living
arrangements
Examples of Havighurst’s Developmental Tasks
Infancy and Early Childhood (0-5 yrs old)
● Learn to walk
● Learn to use the toilet
● Learn to talk
● Learn to form relationship with others
Middle childhood (6-12 yrs old)
● Learn school-related skills such as
reading
● Learn about conscience and values
● Learn to be independent
Adolescence (13-17 yrs old)
● Establish emotional independence
● Learn skills needed for productive
occupation
● Achieve gender-based social role
● Establish mature relationships with
peers
Early adulthood (18-35 yrs old)
● Choose a life partner
● Establish a family
● Take care of a home
● Establish a career
Middle age (36-60 yrs old)
● Maintain a standard of living
● Perform civic and social responsibilities
● Maintain a relationship with spouse
● Adjust to physiological changes
Later maturity (over 60 yrs old)
● Adjust to deteriorating health
● Adjust to retirement
● Meet social and civil obligations
● Adjust to loss of spouse
Newman’s theory
- identifies the tasks of aging as:
● coping with the physical
changes of aging;
● redirecting energy to new
activities and roles, including
retirement, grandparenting, and
widowhood;
● accepting one’s own life;
 ● developing a point of view about
death
Jung’s theory
- proposes that development continues
throughout life by a process of
searching, questioning, and setting
goals that are consistent with the
individual’s personality
- Midlife crisis: can lead to radical career
or lifestyle changes or to the acceptance
of the self as is.
- As aging continues, Jung proposes that
the individual is likely to shift from an
outward focus (with concerns about
success and social position) to a more
inward focus.
- Successful aging, according to Jung,
includes acceptance and valuing of the
self without regard to the view of others.
IMPLICATIONS FOR NURSING
❖ Physical theories of aging indicate
that, although biology places some
limitations on life and life expectancy,
other factors are subject to behavior and
life choices.
❖ Nursing can help individuals achieve
the longest, healthiest lives possible by
promoting good health maintenance
practices and a healthy environment.
❖ Psychosocial theories help explain the
variety of behaviors seen in the aging
population.
❖ Understanding all of these theories can
help nurses recognize problems and
provide nursing interventions that will
help aging individuals successfully meet
the developmental tasks of aging
Chapter 3: PHYSIOLOGIC CHANGES
We can observe many normal changes in the
body’s structure and function during the aging
process.
● There are also changes that indicate the
onset of disease or illness.
● Nurses are expected to be able to
distinguish between normal changes
and abnormal changes that signify a
need for medical or nursing intervention.
● To identify these differences, nurses
must have a good understanding of
the normal body structures and
functions.
● This knowledge should help nurses
understand how normal and abnormal
changes affect the day-to-day functional
abilities of older adults.
● As nurses, we must be aware of
physical changes that are likely to
occur, assess each person to determine
the extent to which these changes have
occurred, and then make our care plans
in response to that individual’s needs.
Integumentary System
 increased risk for pressure ulcers
(breakdown of the skin and tissues
located over bony prominences). This is
a significant problem for immobilized
people such as those who are bedridden
or confined to wheelchairs.

Inflammation and Infection

● Common types of inflammation include
rosacea and various forms of dermatitis.
➢ Rosacea appears as redness,
dilated superficial blood vessels,
and small “pimples” on the nose
and center of the face. It may
spread to cover the cheeks and
chin.
➔ Untreated: lead to
swelling and the
enlargement of the nose
or to conjunctivitis.
➔ Cause: UNKNOWN, but
it is most common in
Common disorders seen with aging: postmenopausal
Integumentary System women, people who
flush easily, and
Basal Cell Carcinoma and Melanoma: individuals taking
● Cases of basal cell carcinoma are vasodilating
commonly observed in older adults who medications
have spent significant amounts of time ➔ Treatment: lifestyle
in the sun. modification, for
● Older men are most at risk for example avoidance of
melanoma, a potentially fatal form of triggers such as
skin cancer because of its ability to stressful situations,
metastasize. extreme heat, sun
● The risk of melanoma doubles if exposure, spicy foods,
someone has had more than five and alcoholic
sunburns at any age. beverages. Oral and
● The unusual appearance of moles topical medications or
should be suspected to be melanoma. light and laser
Irregular shapes, irregular borders, treatments may provide
changes in color, changes in size or some benefits.
symptoms, such as itchiness or
bleeding, are all considered abnormal.

Pressure Ulcers
● Shrinkage in the cushion provided by
subcutaneous tissue along with vascular
changes places the older adult at
 ➢ Contact and allergic
dermatitis appear as rashes or
inflammation that is either
localized to certain areas of the
body or generalized
➢ Seborrheic dermatitis is an
unsightly skin condition
characterized by yellow, waxy
crusts that can be either dry or
moist
Hypothermia
● The decrease in subcutaneous tissue
reduces the older adult’s ability to
regulate body temperature. Very thin
older adults lose the insulation provided
by subcutaneous and adipose tissue.
This loss of insulation is most likely to
result in hypothermia if the person is
exposed to an environment that is too
cold.
Musculoskeletal System
Common disorders seen with aging:
Musculoskeletal System
Osteoporosis
● Excessive loss of calcium from bone
combined with insufficient replacement
results in osteoporosis.
● Common fracture sites include the hip
(usually the femoral neck), ribs, clavicle,
and wrist.
● Osteoporosis is characterized by
porous, brittle, fragile bones that are
susceptible to breakage.
● Spontaneous fracture of the vertebrae
or other bones can occur in the absence
of obvious trauma.
● In fact, spontaneous hip fractures may
lead to a fall, rather than the fall
leading to the hip fracture.
● Simple falls or other traumas are
more likely to result in fractures in
people who have osteoporosis.
● Bone mineral density (BMD) may be
assessed in someone at risk for
osteoporosis.
● Calcium and vitamin D supplements
are necessary for individuals who do not
consume adequate amounts of these
nutrients.
Medications for osteoporosis generally fall into
two categories:
(a) medications that increase bone strength and
density (anabolic drugs); and
(b) medications that inhibit bone loss
(antiresorptive medications).
Commonly prescribed antiresorptive
medications include:
★ alendronate (Fosamax),
★ Risedronate (Actonel),
★ ibandronate (Boniva),
★ raloxifene (Evista),
★ calcitonin (Calcimar)
Newer research is suggesting improved
effectiveness when these two classifications
of medications are given together.
Hormone therapy (HT)
- has beneficial effects on bone density
but also brings increased risk for heart
attack, blood clots, stroke, and breast
cancer.
- Use of HT is controversial and requires
a candid risk/benefit analysis between
the patient and physician.
- If medications are given for
osteoporosis, BMD testing may be done
every 2 years to evaluate treatment.
Degenerative Joint Disease
A. OSTEOARTHRITIS
● Cause: unknown; however, risk
factors have been identified,
including age, obesity, joint
injury or overuse, genetic
predisposition, and muscle
weakness (Arthritis Foundation,
● 2014)
● Pain may occur with activity or
exercise of the affected joints
and may worsen with emotional
stress.
● Synovial membrane of the
bursa may become damaged or
inflamed.
● This is particularly true in the
weight-bearing joints of the
spine, hips, knees, and ankles.
Obesity increases the stress on
joints and can aggravate
symptoms.
● Osteoarthritis is treated with a
combination of exercise,
weight control, joint
protection, physical or
occupational therapy, and
medications (NSAIDs).
B. RHEUMATOID ARTHRITIS
● a collagen disease that results
from an autoimmune process,
affecting more women than men
● causes inflammation of the synovium,
damage to the cartilage and bone of
joints, and instability of ligaments and
tendons that support the joints
● Onset: between ages 30 and 50,
although a significant number of
individuals develop the disease after
age 60.
● characterized by periods of exacerbation
(sometimes called flares), during which
the symptoms are severe and cause
further damage, and remission, during
which the progress of the disease—and
the damage it causes—halts.
Symptoms:
● Pain and stiffness, particularly after rest
● Warm, tender, painful joints
● Fatigue
● Sense of feeling unwell
Treatment:
● NSAIDs
● Corticosteroids
● DMARDs
● Tumor necrosis factor inhibitors
● Interleukin-1 inhibitor

C. BURSITIS
● inflammation of the bursa and the
surrounding fibrous tissue, can result
from excessive stress on a joint or from
a localized infection
● commonly results in joint stiffness and
pain in the shoulder, knee, elbow, and
hip, ultimately leading to restricted or
reduced mobility
● Although bursitis can occur at any age,
age-related changes in the
musculoskeletal system make it more
common in older individuals.
Treatment:
● resting the joint
● NSAIDs
● Corticosteroid preparations - are
occasionally injected into the painful
areas to reduce inflammation.
● Mild range-of-motion exercise - is
encouraged to prevent permanent
reduction or the loss of joint function.
C. GOUTY ARTHRITIS
● caused by an inborn error of metabolism
that results in elevated levels of uric acid
in the body
● Crystals of these acids deposit within
the joints and other tissues, causing
episodes of severe, painful joint
swelling.
● Some joints, such as those of the great
toe, are more commonly affected.
● Chills and fever may accompany a
severe attack.
● Attacks of gout become more frequent
with age.
Untreated, this disease can result in joint
destruction.
- It is observed more often in men but is
also common in postmenopausal
women.
Recommendations may include reduction of
body weight and decreased intake of alcohol
and foods rich in purines, such as liver or dried
beans or peas.
Respiratory System
Common disorders seen with aging:
Respiratory System
Chronic obstructive pulmonary disease
(COPD)
● an umbrella term for the commonly
occurring respiratory disorders of
emphysema and chronic bronchitis.
● often occur together and may coexist
with asthma
● common in people who have a history of
smoking or who have had a high level of
exposure to environmental pollutants.
Symptoms of COPD:
● productive cough
● wheezing, cyanosis
● dyspnea on exertion.
They are at higher risk for developing
respiratory tract infections; in severe cases,
respiratory failure can occur.
Emphysema is characterized by changes in
alveolar structure. The alveoli lose elasticity,
become overinflated, and are ineffective in gas
exchange.
Chronic bronchitis involves inflammation of the
trachea and bronchioles. Chronic irritation leads
to excessive mucus secretion and a productive
cough.
Onset of symptoms is sudden;
Symptoms: chills, fever, cough, sore
throat, and general malaise and may
be dramatic and leave the victim
feeling severely ill.
Pneumonia
● is acute inflammation of the lungs
caused by bacterial, viral, fungal,
chemical, or mechanical agents.
● In response to the agent, the alveoli and
bronchioles become clogged with a
thick, fibrous substance that decreases
the ability of the lung to exchange
gases.
● Pneumonia can progress to a state in
which the exudate fills the lung lobes,
which then become consolidated or firm.
- can be detected by radiologic
examination
A. Viral pneumonia (walking pneumonia)
Symptoms:
● Headache
● Fever
● aching muscles
● cough with mucopurulent
sputum

Influenza Treatment:
● often referred to as the flu, is a highly ● varies according to the
contagious respiratory infection caused symptoms
by a variety of influenza viruses.
● Influenza presents a special danger for B. Bacterial pneumonia
older adults with a history of respiratory Cause: Staphylococcus, Streptococcus,
disease or other debilitating conditions. Klebsiella, and Legionella
● Yearly flu shots are recommended for all
persons older than 65 years of age to Symptoms:
reduce the chance of contracting ● abrupt and dramatic in onset.
influenza. ● Chills, fever up to 105° F,
elevated WBC count
Transmission: airborne droplets and moves (leukocytosis), tachycardia, and
quickly through groups of people who live or tachypnea are common, as is
work in close contact with one another. pain with respiration, or
dyspnea.
Incubation period: brief, often only 1 to 3 days
from the time of exposure Lung Cancer (bronchogenic cancer)
 ● One of the most deadly forms of cancer
in the US
● diagnosis peaks is 55 to 65 years
● results from exposure to carcinogenic,
or cancer-causing agents, particularly
tobacco smoke, air pollution, asbestos,
and other hazardous industrial
substances.

Symptoms:
● Cough
● Chest pain, Common disorders seen with aging:
● blood-tinged sputum Cardiovascular System

Coronary Artery Disease

Treatment Of Choice:
● surgical resection of the lungs
- This procedure is associated
with a high mortality rate in older
adults.
● Radiation and chemotherapy
- are used in some patients, with
varying amounts of success
Cardiovascular System
● Many older adults have seriously
obstructed coronary arteries, yet they
remain essentially asymptomatic.
● Once circulation to the heart muscle
decreases significantly, the amount of
oxygen delivered to the heart decreases
and ischemia occurs.
● The pain that may be experienced with
ischemia is referred to as angina
pectoris (literally, chest pain).
● People experiencing an angina attack
are advised to decrease their activity
and rest until the episode passes.
● coronary vasodilators, such as
nitroglycerin, or β-adrenergic blocking
agents for people with ischemic heart
disease are prescribed.
● When one or more coronary arteries
become totally obstructed by
atherosclerosis or embolus, the person
is said to have a myocardial infarction
(MI), or heart attack.

● Moderate damage may limit a person’s

physical activity. Extensive damage or
damage to a critical area of the heart
may result in death.
Coronary Valve Disease
 ● heart valves become less pliable over
time
● calcium deposits may develop on the
valves, preventing them from sealing
completely.
● This can result in mitral valve prolapse,
mitral regurgitation, and, ultimately,
heart failure (HF).
Symptoms of mitral valve prolapse:
● chest pain
● Palpitations
● Fatigue
● Dyspnea
● Calcium deposits on the valves roughen
the lining and increase the risk for clot
formation in the chambers of the heart
and in the blood vessels.
Cardiac arrhythmias, including ventricular
arrhythmias, atrial fibrillation, and
conduction disturbances, are increasingly
common with aging.
Heart block is a common conduction
disturbance caused by disruption of the
electrical conduction system of the heart.
Heart Failure (HF)
● primarily a problem of the aging
population
● estimated that more than 2 million
people suffer from this disorder,
resulting in almost one million
hospitalizations each year
● the patient’s lungs are often congested,
and edema appears because the heart’s
pumping action is ineffective
● HF is not a single disease but rather a
syndrome that accompanies and results
from many other disorders.
Medical management:
★ dietary restriction of sodium to decrease
fluid retention
★ administration of diuretics (e.g.,
furosemide) to reduce fluid overload
★ administration of cardiotonic
medications (e.g., digoxin) increase the
pumping efficiency of the heart
★ planned levels of activity designed to
reduce cardiac workload
★ Use of medical devices, including
pacemakers, left ventricle assist
devices, and implanted sensors, is
increasingly common.
Cardiomegaly
● or enlargement of the heart, which is
often related to chronic HF
● As we age, the muscular wall of the left
ventricle thickens.
● Because arteries and veins lose
elasticity with age, the heart must pump
harder to move blood through the
vessels.
● The muscles of the left ventricle
hypertrophy in an attempt to improve the
output of blood from the heart to meet
the body’s tissue demands for
oxygenated blood.
Peripheral Vascular Disease
A. ARTERIOSCLEROSIS:
- the walls of the arteries become
less elastic and plaque forms in
the lumen, further restricting
blood flow
- Excessive plaque is often
related to lifestyle factors or to
other disease conditions, most
commonly obesity, high
cholesterol intake, cigarette
smoking, and diabetes mellitus
(DM).
- decreased blood flow deprives
the tissue of oxygen and
nutrients and causes ischemia.
- If the lumen is completely
obstructed, tissue death may
result.

Occlusive Peripheral Vascular Problems
● Thrombus formation (clotting) in the
lumen of a vein is a common problem,
particularly in immobile older adults.
● These clots can form quickly because of
sluggish blood flow within the vessels.
● Increasing the patient’s activity and
using antiembolism stockings help
prevent problems related to venous
stasis or pooling.
● most often in lower extremity veins,
where they irritate and inflame the
vessel and cause thrombophlebitis.
● If a thrombus breaks loose from the vein
and travels in the circulatory system, it is
referred to as an embolus.
Signs:
● Edema
● Swelling
● warmth over the affected area
● Aching
● Cyanosis
● pallor
Medical management:
★ Rest,
★ elevation of the affected leg
★ application of elastic stockings or wraps
★ administration of analgesics
★ anticoagulant therapy
★ sometimes application of heat
Varicose Veins
● seen when blood pools in the veins and
dilates or stretches them.
● The decrease in vascular muscle tone
that occurs with aging increases the risk
for this.
● Varicosities are most often seen as a
twisting discoloration in the superficial
veins of the lower extremities.
● Older adults who are obese, are
inactive, or spend a great deal of time
standing are more likely to have
varicosities.
● The risk for inflamed varicosities
increases with age.
● Varicosities can result in leg cramps or a
dull, aching pain in the legs.
Prevention:
● avoiding constricting garments, such as
garters or rolled stockings,
● refraining from sitting with crossed legs
● by increasing activity
● by resting with the legs elevated
● by wearing elastic stockings that
promote venous return
Aneurysm
● the pouching or ballooning of arteries, is
common in older adults who suffer from
arteriosclerotic blood vessel changes
● Older adults with a history of angina, MI,
or HF are at increased risk for
developing aneurysms
● Aneurysms of the abdominal aorta are
most common in older adults.
● Rupture of an aneurysm results in
massive, life threatening hemorrhage.
● Early detection and surgical repair of the
damaged area provide the best chance
for survival.

Hypertensive Disease
● prevalent in the older-adult population
● categorized as essential (primary) or
secondary
● Essential hypertension: gradual onset,
often asymptomatic until complications
arise
● It is diagnosed based on two elevated
blood pressure determinations on three
separate days.
● A reading of 140/90 mm Hg is
considered the upper limit of normal in
adults. (James et al, 2014).
Essential hypertension cannot be cured, but it
can be treated.
Treatment:
★ nonpharmacologic approaches: rest
smoking cessation, use of stress-
reduction techniques, weight loss, and
dietary sodium restriction.
★ Pharmacologic approaches: thiazide
diuretic, a calcium channel blocker, and
either an angiotensin-converting
enzyme inhibitor, or angiotensin
receptor blocker (but not both) (James
et al, 2014).
★ patient must be monitored continuously
to determine the effectiveness of
therapy.
★ Treatment of secondary hypertension
directed at the underlying pathologic
condition.
HEMATOPOIETIC AND LYMPHATIC
SYSTEMS
Common disorders seen with aging:
Hematopoietic and Lymphatic Systems
Anemia
● defined as inadequate levels of RBCs or
insufficient hemoglobin.
● The most commonly observed anemias
in older adults are iron-deficiency
anemia, pernicious anemia, and folic-
acid-deficiency anemia.
Leukemia
● result of excessive production of
immature WBCs.
● Chronic lymphocytic leukemia is the
form most often seen in older adults.
● The average age at diagnosis is 72
years (American Cancer Society, 2014b)
● Depending on the stage of the disease
and the patient’s overall health, life
expectancy
 ● Rectal Prolapse

GASTROINTESTINAL SYSTEM

URINARY SYSTEM

Common disorders seen with aging:

Gastrointestinal System
● Hiatal Hernia
● Gastroesophageal reflux disease Common disorders seen with aging: Urinary
(GERD) System
● Gastritis and Ulcers ● Urinary Incontinence
● Diverticulosis and Diverticulitis ● Urinary Tract Infection
● Colon Cancer ● Chronic Renal Failure
● Hemorrhoids
 SPECIAL SENSES

NERVOUS SYSTEM

Common disorders seen with aging: Special

Sense - EARS
● Otosclerosis
- Abnormal bone growth in the
ear especially in the middle ear

● Tinnitus
- Ringing that come inside the
body
● Deafness
● Ménière Disease
Common disorders seen with aging:
- Combination of vertigo and
Nervous System
tinnitus
● Parkinson Disease
● Dementia
● Alzheimer Disease
● Transient Ischemic Attack (TIA)
● Stroke
 Common disorders seen with aging:
REPRODUCTIVE AND GENITOURINARY
SYSTEMS
● Uterine Prolapse
● Vaginal Infection
● Breast Cancer
● Prostate Cancer

ENDOCRINE SYSTEM

Common disorders seen with aging: CHAPTER 4: HEALTH PROMOTİON HEALTH

ENDOCRINE SYSTEM MAİNTENANCE AND HOME HEALTH
● Diabetes Mellitus CONSİDERATİONS
● Hypoglycemia
● Hypothyroidism "Health maintenance is an ongoing challenge for
older adults, their families, and health care
providers."

REPRODUCTIVE AND GENITOURINARY

SYSTEMS Advice for the Young Youths
● Accept that you are getting older—
adjust to the changes, and plan for
possibilities.
● Explore options for the future—look for
things you want to accomplish in your
life.
● Find work or creative outlets that make
you happy— look for ways to grow
throughout your life.
● Modify your lifestyle to promote health—
exercise, eat healthy foods, and manage
stress.
 ● Develop and maintain relationships— c. Occasional or moderate alcohol
bonds formed with friends and loved consumption by older adults
ones provide support; we can never usually is not prohibited unless
have too many. some medical condition or
medication precludes its use.
RECOMMENDED HEALTH PRACTICES FOR
OLDER ADULTS 4. PHYSICAL EXAMINATIONS AND
1. DIET PREVENTIVE OVERALL CARE
a. Older adults should consume a a. Annual Examination by their
well-balanced, plant- based diet primary care providers more
with the recommended daily often if known health problems
allowances of nutrients. exist.
b. Delay in the recognition of
problems may make them more
difficult and expensive to treat.
c. Physical examinations should
include evaluations of height
and weight, blood pressure, and
a rectal examination.
d. Women should have a pelvic
examination, mammogram,
Papanicolaou (Pap) test, and
bone mineral density
e. Evaluation of joints, feet, and
gait should be part of the
physical examination.
f. Immunization:
i. PNEUMOCOCAL
VACCINE
ii. INFLUENZA (FLU)
VACCINE
iii. TETANUS,
2. EXERCISE
DIPTHERIA,
a. Daily exercise should be part of
PERTUSSIS
the plan for older adults.
VACCINES
b. Exercise can help keep joints
iv. SHINGLES (ZOSTER)
flexible, maintain muscle mass,
VACCINE
control blood glucose levels and
v. HEPATITIS B
weight, and promote a sense of
VACCINE based on
well-being.
individual risk factors
3. TOBACCO AND ALCOHOL
5. MEDICATION
a. It is never too late to stop
a. Take prescription medications
smoking. Even the body of an
only as ordered.
older person can repair damage
b. Store medication as directed.
once smoking is discontinued
c. Report any suspected side
b. Excessive consumption of
effects to your primary care
alcoholic beverages is never
provider
recommended.
 d. Keep a card with names of all FACTORS THAT AFFECT HEALTH
medications, dose, and name of PROMOTION AND MAINTENANCE
primary care provider with you
at all times. Keep the card up to Health perceptions and health maintenance
date. practices in older adults are influenced by the
e. Show the card to all health care following:
providers. ● Personal Beliefs
f. Wear a medical alert bracelet, ● Religious and Cultural Beliefs
listing serious diseases and ● Socioeconomic Status
allergies. ● Education
g. Do not use OTC medication ● Life Experiences
without consulting primary care
provider or pharmacist. 1. RELIGIOUS BELIEFS
h. Do not take anyone else’s a. These beliefs can promote
medication or share your maintenance or interfere with
medication with anyone. good health practices and result
in increased health risks
6. DENTAL EXAMINATIONS AND
PREVENTIVE ORAL CARE 2. CULTURAL BELIEFS
a. Annual dental examinations a. Culture plays a significant role in
should be obtained the selection of food and the
b. Use soft-bristle brushes to clean methods used for food
all tooth surfaces. preparation. These preferences
c. Brushing teeth twice daily using and practices play an important
fluoride toothpaste and should role in health promotion and
floss carefully between the teeth maintenance.
d. Circular or short back-and-forth b. As our society becomes
brushing works best to clean the increasingly diverse, nurses
teeth. need to become more aware of
e. Dentures must be brushed or the religious and cultural factors
cleaned at least once a day to that affect the health-
remove food debris, bacteria, maintenance practices of all
and stains, and to prevent gum persons.
irritation or bad breath. c. The following groups have
higher rates of the following
disorders:
7. MAINTAINING HEALTHY ATTITUDE i. Hypertension: African-
a. Strong connections exist American population
between the mind and body. ii. Diabetes: African-
b. Older adults who maintain a American,
positive outlook on life tend to Hispanic/Latino,
follow good practices and American-Indian, Asian-
remain healthier longer life American, and Pacific
c. Regular interaction with other Islander–American
people of all age groups helps populations
maintain a positive attitude iii. Stomach cancer:
toward life Hispanic-American,
African-American, and
 Asian/Pacific Islander
populations 7. IMPACT OF CHANGES RELATED TO
iv. Cervical cancer: ACCESSIBILITY
Hispanic-American and a. Physical limitations including
African-American loss of motor skills, decreased
populations strength and endurance, and
v. Breast cancer: White the presence of disease, make
women health-maintenance activities
vi. Obesity: African- more difficult.
American, American-
Indian/Alaskan Native, HOME HEALTH
and Hispanic-American Home health interventions can both promote
populations health and help the older person maintain the
highest level of function possible for the longest
3. KNOWLEDGE AND MOTIVATIONS period of time.
a. Knowledge plays a key role, in 1. UNPAID CAREGIVERS
maintaining health and a. Most unpaid caregivers are
promoting safety; knowledge of family or friends of the older
recommended health practices adult, although they may be
is essential to make good volunteers from a church or
choices. other charitable organization.
b. Health and safety teaching must 2. PAID CAREGIVERS
start early and be reinforced a. Agencies provide home
throughout life. services. Caregivers should
provide certification that they
4. MOBILITY are free of communicable
a. Even people who are diseases, including tuberculosis.
knowledgeable and motivated to
maintain their health may have TYPES OF HOME SERVICES
trouble if they cannot obtain the Services are best delivered by a team that
goods or services they need. includes RNs, licensed practical nurses (LPNs)/
b. People with limited physical licensed vocational nurses (LVNs), health aides,
mobility, transportation, or house-keepers, dietitians, and social workers, as
money are likely to experience well as occupational, physical, and speech
difficulty. therapists.

5. PERCEPTIONS OF AGING
a. Perceptions regarding aging
greatly affect a person’s
motivation and willingness to
participate in health-
maintenance activities.

6. IMPACT OF COGNITIVE AND

SENSORY CHANGES
a. Older adults who are seriously
impaired either perceptually or
cognitively commonly lack
awareness of their own needs.
 health maintenance are to
verbalize appropriate health
maintenance practices,
demonstrate adequate health
maintenance practices, and
identify community resources
that can assist in health
maintenance

IV. NURSING INTERVENTIONS/

IMPLEMENTATIONS
A. Assess the older adult’s ability
to resume normal health
maintenance practices.
B. Teach the skills required to
monitor health status when the
patient returns home.
C. Consult with the social worker or
with agencies that can assist
with health- maintenance
NURSING PROCESS FOR INEFFECTIVE practices.
HEALTH MAINTENANCE AND INEFFECTIVE D. The following interventions
HEALTH MANAGE should take in the home:
1. Assess the existing
I. ASSESSMENT AND COLLECTION OF health-maintenance
DATA practices.
A. How does the person rate his or 2. Explain and reinforce
her current health? positive health-
B. Does the person feel in control maintenance behaviors.
of the conditions that affect his 3. Assist in identifying
or her health? family or community
C. What does the person routinely resources that promote
do to maintain his or her health? health maintenance.
D. How does the person manage 4. Use any appropriate
illnesses? interventions that are
E. What is the person’s religious or used in the institutional
cultural beliefs regarding health setting.
and health practices?
F. How do the person’s health
practices compare with
recommended health practices?

II. NURSING DIAGNOSES

A. Ineffective health management
B. Ineffective health maintenance
III. NURSING GOALS/OUTCOMES
A. The nursing goals for an older
adult demonstrating ineffective
 factors that contribute to
noncompliant behavior

IV. NURSING INTERVENTIONS

A. The following nursing
interventions for noncompliance
should take place in hospitals or
extended-care facilities:
1. Identify the reasons for
noncompliant behavior
2. Provide care in a
nonjudgmental manner.
NURSING PROCESS FOR NONCOMPLIANCE
3. Actively include the
The current NANDA terminology includes the
patient in planning care
nursing diagnosis “noncompliance,” so that will
and adapt or modify the
be the primary word used in this text to describe
care plan so that it is
the lack of following the prescribed treatment
more acceptable to the
plan.
patient.
4. Emphasize the benefits
I. ASSESSMENT/DATA COLLECTION
of compliant behavior.
A. Does the person verbalize
5. Acknowledge the aging
unwillingness or inability o follow
person’s right not to
through with the necessary
comply with the plan of
health maintenance or medical
care.
care recommendations?
B. The following interventions
B. Does the person verbalize a
should take place in the home:
conflict between personal
1. Assess the support
beliefs or values and the
system.
treatment plan?
2. Help structure the
C. Are there unexpected relapses,
environment to promote
or do the health problem?
compliance.
3. Enlist the help of family,
friends, and neighbors
to provide reminders.
4. Involve social service
agencies in promoting
compliance.
5. Use any appropriate
interventions that are
used in the institutional
setting.
II. NURSING DIAGNOSIS
A. Non-Compliance

III. PATIENTS GOALS/OUTCOMES

A. The patient goals for an older
person demonstrating
noncompliance are to identify